fpsyg-10-01521 June 28, 2019 Time: 15:14 # 1 ORIGINAL RESEARCH published: 02 July 2019 doi: 10.3389/fpsyg.2019.01521 Putting Oneself in the Body of Others: A Pilot Study on the Efficacy of an Embodied Virtual Reality System to Generate Self-Compassion Ausiàs Cebolla1,2, Rocío Herrero2,3*, Sara Ventura1, Marta Miragall1,2, Miguel Bellosta-Batalla1, Roberto Llorens4,5 and Rosa Ma Baños1,2 1 Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain, 2 CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain, 3 Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castelló, Spain, 4 Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain, 5 Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales Vithas-NISA, Fundación Hospitales NISA, Valencia, Spain Compassion-based interventions (CBIs) have been shown to be effective for increasing Edited by: Stéphane Bouchard, empathy and compassion, and reducing stress, anxiety, and depression. CBIs are Université du Québec en Outaouais, based on constructive meditations where imagery abilities are essential. One of the Canada major difficulties that participants report during the training is the difficulty related to Reviewed by: Joaquim Soler, imagery abilities. Virtual reality (VR) can be a useful tool to overcome this limitation Psychologist, Spain because it can facilitate the construction and sustainment of mental images. The Marcela Matos, machine to be another (TMTBA) uses multi-sensory stimulation to induce a body swap University of Coimbra, Portugal illusion. This system allows participants to see themselves from a third perspective and *Correspondence: Rocío Herrero have the illusion of touching themselves from outside. The main objective of the present [email protected] study was to analyze the efficacy of a self-compassion meditation procedure based on the TMTBA system versus the usual meditation procedure (CAU) in increasing positive Specialty section: This article was submitted to affect states, mindful self-care, and adherence to the practice, and explore the influence Human-Media Interaction, of imagery abilities as moderators of the effects of the condition on adherence. A sample a section of the journal Frontiers in Psychology of 16 participants were randomly assigned to two conditions: TMTBA-VR and CAU. All Received: 19 December 2018 participants had to listen to an audio meditation about self-compassion and answer Accepted: 17 June 2019 questionnaires before and after the training. The TMTBA-VR condition also had a body Published: 02 July 2019 swap experience at the end of the meditation while listening to self-compassionate Citation: messages. Afterward, they were invited to practice this meditation for 2 weeks and Cebolla A, Herrero R, Ventura S, Miragall M, Bellosta-Batalla M, then measured again. After the compassion practice, both conditions significantly Llorens R and Baños RMa (2019) increased positive qualities toward self/others, decreased negative qualities toward self, Putting Oneself in the Body of Others: A Pilot Study on the Efficacy of an and increased awareness and attention to mental events and bodily sensations, with Embodied Virtual Reality System no differences between the conditions. After 2 weeks, both conditions showed a similar to Generate Self-Compassion. frequency of meditation practice and increases in specific types of self-care behaviors, Front. Psychol. 10:1521. doi: 10.3389/fpsyg.2019.01521 with the frequency of clinical self-care behaviors being significantly higher in TMTBA. Frontiers in Psychology| www.frontiersin.org 1 July 2019| Volume 10| Article 1521 fpsyg-10-01521 June 28, 2019 Time: 15:14 # 2 Cebolla et al. Embodied Virtual Reality for Self-Compassion Finally, lower imagery ability in the visual and cutaneous modality were moderators of the efficacy of the TMTBA (vs. CAU) condition in increasing adherence to the practice. Embodied VR could be an interesting tool to facilitate and increase the efficacy of CBIs by facilitating the construction of positive and powerful mental images. Keywords: compassion, virtual reality, body swapping, full body illusion, self-compassion, mindfulness, meditation INTRODUCTION a significant factor. Finally, transformation includes the capacity for rotation and restructuring. Compassion-based interventions have been shown to be effective Although the effects of compassion and self-compassion in increasing empathy and compassion (Brito et al., 2018), and training are well known, the factors that predict why the reducing stress, anxiety, and depression (Kirby et al., 2017). They training works for some people and not for others have been have been used in clinical settings, such as oncology (Gonzalez- understudied. In this regard, the absence of adequate training Hernandez et al., 2018) or personality disorders (Feliu–Soler in the ability to create, sustain, inspect, or transform mental et al., 2017). Compassion refers to “the feeling that arises in images may impede the expected positive effects of compassion witnessing another’s suffering and that motivates a subsequent training. This lack of ability can lead people to struggle with steps desire to help”(Goetz et al., 2010, p. 351). When this feeling prior to the compassion itself, and this experience can discourage is focused on oneself, it is called self-compassion, defined as people from continuing the necessary training to develop the individuals’ ability to respond to their own suffering with warmth compassion skills, like self-care or positive qualities (compassion, and the desire to alleviate their own pain (Neff and Dahm, 2015). equanimity, joy, or loving kindness). Compassion-based interventions use different techniques Virtual reality can be a useful tool to overcome this and meditations to achieve the objective of increasing self- limitation because it can help to construct, sustain, inspect, and compassion and compassion skills, such as focused attention transform mental images. VR can be considered an advanced meditations to calm the mind and, mainly, the family of imagery system and an experiential form of imagery that is constructive meditations (Dahl et al., 2015). In this family of as effective as reality in inducing cognitive, emotional, and meditation practices, the meditator purposefully strengthens behavioral responses (Day et al., 2004). VR has been used to his/her natural capacity for loving kindness and compassion train compassion and self-compassion. For instance, Slater’s by intentionally generating compassionate thoughts, feelings, group studied how the use of virtual bodies can promote and motivations toward different objects, including him/herself compassion and self-compassion by analyzing the effects of (Brito et al., 2018). self-identification with virtual bodies within immersive VR on In order to induce and train these positive mental states, the increasing self-compassion in individuals with high self-criticism family of constructive meditations requires the use of mental and depression (Falconer et al., 2014) showing how could be imagery abilities. Surprisingly, the impact of these imagery effective in reducing depression severity and self-criticism. The skills on CBIs has not been studied, even though one of the same group investigated how an embodied black avatar decreases major difficulties that participants report during the training is racial prejudice and changes negative interpersonal attitudes related to these imagery abilities. According to Pearson et al. (Peck et al., 2013). Bailenson’s group also studied how an (2013), there are four different mental imagery skills related to embodied avatar in VR can make people more altruist. For different processes that could be interacting with these types of example, participants embodied a Superman avatar, and the meditation: (a) creation, (b) sustainment, (c) inspection, and (d) results showed that they felt more helpful after the experiment transformation of mental images. In creation, the meditators have (Rosenberg et al., 2013). to select the type of images or elements that will be used in the All these studies use embodied VR systems, which is a meditation. In the second process, the sustainment of the mental cognitive science approach that emphasizes, among other aspects, image, research shows that after 250 ms (the time necessary for the subjective experience of using and “having” a body. This eye movement) (Kosslyn, 1994), the image starts to decay. Thus, paradigm has been used to generate Full Body Illusions (Ehrsson, participants usually have to deal with the frustration of not being 2007) and body swapping experiments, which have become able to sustain the image long enough, which could interact an increasingly popular method for investigating how illusory with their positive emotional state. The third aspect, inspection, ownership of an entire fake or virtual body affects various refers to the interpretation of an object-based characteristic or aspects of bodily perception and experience. Thus, VR allows spatial property of this generated image. For example, the lack individuals to be present not only in the environment, but also of definition (blurred) and vividness of the mental image is also in someone else body. VR allows the person to be “inside” another body (e.g., another person or animal), creating a Abbreviations: CBIs, compassion-based interventions; GAD-7, the generalized